Accredited by The Joint Commission since 1986, the Tamarack Center provides top-tier residential psychiatric treatment to adolescents in Spokane, Washington. In addition to a web page devoted to “Accreditation and Licensing” on their site, they also display the Gold Seal of Approval logo from The Joint Commission. Recently, Tim Davis, CEO at Tamarack Center expanded on the importance of accreditation and its significance to his organization.
Tamarack achieved accreditation because their contract with the state required it. Though the process and its aftermath helped turn Executive Director Tim Davis into a strong advocate for the benefits of being accredited.
In this interview with Accreditation Guru, Tim contends that accreditation limits liability, attracts top talent and convinces parents to trust their children’s care to Tamarack. You may even be able to negotiate a discount with your insurance carrier.
What are some of the prime benefits of accreditation?
With the world being so litigious, you want to limit liability. You don’t want to be out there without some form of accreditation, which is a statement about how you do things. Plus, you’re regularly reviewed by outside parties on a continuous improvement plan.
Over the last 35 years I’ve seen a lot of people who never thought about these things. Now realizing it’s not only smart to do, but it also offers huge protection in any disagreement or litigation.
The legal protection is so important, especially in [the behavioral health] world. Something bad can happen at any time, be it a successful suicide, a sexual assault, running away, being harmed or harming someone.
Typically, the basis of any lawsuit is that the institution had no idea what they were doing. From the parental perspective, it’s “I left my child in their care and they have no idea how to handle my kid.”
When it gets to that point, attorneys say that it’s helpful to show that you’re adhering to accreditation standards over a period of time. That you’ve thoroughly covered your processes and you’re dedicated to running the place with that in mind. You can even show surveys where they found deficiencies and you took steps to correct that issue as an ongoing daily process.
It ensures that you’re paying attention to the environment of care and ethical standards. Then, you have a much stronger defense. Otherwise, it’s he-said-she-said, back and forth. I value this kind of protection.
To what do you attribute a rise in knowledge about accreditation?
There’s a little more awareness each year. People go on the web and begin to understand. Now, insurance companies are spreading the word and getting more involved.
Really? That’s interesting. Do insurance companies offer discounts to organizations that are accredited?
[Laughs.] I’ve never heard of that, but they should.
[Accreditation Guru note: Some liability insurance companies will take into account accreditation when determining the cost of liability insurance for a residential program because they view accreditation as an acceptable risk reduction strategy. The cost saving may be the result of a direct discount on premiums or due to having accreditation status gives the program a better rating that results in a reduced rate.]
You mentioned that you operate in a distinct environment.
Over the years, there have been a lot of conversations about residential care for kids. There are a lot of unlicensed, rogue programs that certainly aren’t accredited who think they know how to heal problem kids.
A lot of boot camp style centers got a lot of publicity on Dr. Phil and NBC News, but the residential treatment centers that are accredited can’t do things that people consider to be rogue. They made a commitment to do just the opposite, with a set of agreed upon standards.
We talk about assessment and such a key part of anything you do is to try and understand what the conditions are and what your organization can do for them. I tell parents that we’re going to do a mountain of assessments and you can have access to all of this and decide on the course of treatment.
The rogue operators say “just let Johnny stay with us two months and you’ll get a different kid back.” Are they going to do legitimate service to families? One way to do that is to adhere to an agreed upon set of standards.
Why don’t more residential treatment centers become accredited?
It’s not an easy thing to do and it represents an expense. But our organization considers it money well spent.
When I talk with non-accredited places, I realize how fortunate I am. I’ve got a high bed rate, top-flight staff and a high level of safety. Other places may have a lower bed rate and take kids because they need to fill the beds, but they may not be equipped to deal with suicidal or psychotic kids and if they have three people with a high school equivalence working the floor and a psychiatrist who comes in two hours a month, that’s a nightmare.
Sometimes, nonprofits can be naive about the mission, thinking that all you need to take care of disturbed kids is “if you hug ‘em and feed ‘em, they’ll get better,” but that’s where accreditation comes in. It adds a level of seriousness and professionalism that you can’t get anywhere else.
My biggest battle with the state is that our accreditation defines the scope of care – we have 16 beds and we’ve decided that there are certain types of kids we can’t serve and the state goes crazy when we declare that a placement might be out of our scope of care, which is the foundation of our contract.
Nonprofits that don’t define their scope of care get into a tremendous mess when they take people for whom they can’t provide appropriate services. I talk with people who are licensed, including nurses and doctors and tell them that they never want to work in a place that is not accredited because it provides a bit of a safety net for your license if something goes haywire. And it will.
In behavioral health they can come after you, but in most cases you will be protected because the heart of the argument is “what kind of place is this?” Is it a ragtag outfit or a professional medical environment? All you need to know is that it’s accredited.
There’s always going to be resistance to accreditation in the beginning due to the amount of work. And yeah, it’s more work, but it’s not insurmountable. With The Joint Commission, there are many ways you can meet a standard, they’re not dictatorial. Accreditation gives you and your staff accountability in this highly unpredictable, litigious field of work.
Does accreditation help with your marketing? Do parents know about it?
We’re small and we’re almost always full, so we don’t do much marketing. But we do speak with parents all the time who ask “why should I leave my child here? What can we expect?” And accreditation is a big part of that conversation.
I actually show them The Joint Commission manual and tell them “here are the things for which we are held accountable” and I let them spend as much time as they want asking me about our internal processes, making sure that something in the manual is happening.
It’s a big part of helping parents feel comfortable putting their child here. They know that there is some system in place that we have been doing for years and our standards of care are at the same level as the best providers across the country. It’s comforting for them.
Spokane is a small place, so if something bad happens, people talk about it and if it turns out that a place has no accreditation, I use it as an opportunity. I tell people that I have this written road map about how to care for people ethically and efficiently. Then, outside people come in and put you under the microscope and say “are these guys doing this or not?”
We’re licensed in Washington state five ways and the license reviews and audits are really specific. They’ll look at the fridge or run a white glove over something, but they’re not getting the full picture of care. Accreditation does.
So when there’s an incident in town, you spring into crisis coordination mode?
People inevitably ask “how could that happen?” The worst answer you can give is that the system broke down. If you can answer that a person made a mistake or willfully performed a bad act, people are more understanding because as humans, those things can happen. The public is less understanding of people who run something where the system allows a mess.
You had no background in accreditation when you took over at Tamarack, right?
I was a clinical guy and knew little about the management side of nonprofits, but The Joint Commission laid out what I had to do if I’m managing the thing properly.
Like everything, there was a learning curve, but the key – when I look back – is to understand the philosophy of each standard. What’s really important is that once you get this, then the whole accreditation process makes ten times more sense.
You ask yourself, “is it really important to do that?” If the answer is no, then ask, “why not, if that’s the standard?” You’d be amazed how many times we ask “is it important to do that?” and at first people might say “that’s stupid, we don’t need that.” And then, inevitably, you look around the table and people are shaking their heads saying “yeah, this makes sense.”
For new young management like me, the standards themselves served as a mentor or guiding force.
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